Healing in the traumatized spleen: sonographic investigation.

Abstract

In 16 patients with abdominal trauma, ultrasonic abnormalities of the spleen were demonstrated shortly after trauma (mean 3.7 days). Initial sonographic abnormalities included: splenic laceration in 3 cases, intrasplenic fluid (hematoma) in 4, splenic inhomogeneity (contusion) in 8, perisplenic fluid (subcapsular hematoma) in 11, intraperitoneal fluid in 10, and a left pleural effusion in 7. Follow-up sonograms showed that pleural effusions and intraperitoneal fluid collections disappeared quickly (2 and 4 weeks, respectively). However, intrasplenic hematomas and contusions usually resorbed over a period of months (up to a year). When followed to complete resolution, the spleen may become normal sonographically or there may be small linear foci of echogenic material, which probably represent scar tissue.

Spleen

“…Intraparenchymal hemorrhage may initially appear hyperechoic, 12 but larger collections of unclotted blood are initially anechoic to hypoechoic. 13 Based on these studies, it seems that splenic hematomas may persist for extended periods. 13 This has been ascribed to red blood cell lysis and clot retraction.…”

“…[11][12][13] Extramedullary hematopoiesis, acute myeloproliferative disorders, and increased reticuloendothelial activity have also been reported to cause normal or reduced echogenicity of the spleen in humans. Anesthetics, infection, immune-mediated disease, lymphoma, leukemias, neoplasia, vascular stasis, chronic hemolytic anemia, torsion, and parasitic infections (e.g., Haemobartonella, Babesia, or Ehrlichia) are known to cause diffuse enlargement of the spleen.…”

Pleural effusion due to nonmalignant gastrointestinal disease

“…PE occurs in 60-80% of cases of subphrenic abscess. These abscesses occur following a surgical procedure such as a splenectomy or gastrectomy in a time interval ranging from some weeks to several months from the intervention [127]. Sometimes, PE results from a perforated organ (for instance, of the appendix), diverticulitis, cholecystitis, or trauma.…”

The Complete Spleen

“…7). Subsequent scans may show clearing of this heterogeneity, leading to the presence of a relatively anechoic, cystic structure representing the resolving hematoma (Lupien and Sauerbrei, 1984). These anechoic fluid collections may then decrease in size, and disappear, or leave a small scar manifested as an echogenic line.…”